Military Medicine最新文献

Introduction: Assessing military medical teams' ability to respond to large-scale mass casualty (MASCAL) events has become a priority in preparing for future conflicts. MASCAL exercises rely on large numbers of simulated patients with limited medical training. Role-players must be appropriately prepared to ensure that medical exercises adequately assess the expected capabilities of military medical units. The Uniformed Services University of the Health Sciences (USUHS) has evaluated future military providers for decades using a large-scale, multiday, immersive simulation called Bushmaster. Despite a robust casualty training system, the fidelity of the portrayals remained limited.

Materials and methods: Through collaboration with national military medical experts, a comprehensive casualty depiction system was developed. This system relied on structured casualty cards linked to time-based illness scripts. Structured casualty cards included an appropriate balance of disease non-battle injuries and trauma, included multipatient presentations based on shared events (i.e., multiple injured personnel due to an aircraft crash), normal and pathologic combat stress, population/unit considerations, requirements for different roles within the medical unit, and expected clinical outcomes. Illness scripts, supplemented by video guides, included time-based courses of illness/injury and prescribed responses to different typical treatments. This system was piloted during an annual MASCAL exercise (Operation Bushmaster) at USUHS. Clinical faculty were queried on the fidelity of this new system while role-players were evaluated on feasibility.

Results: Three hundred casualty cards linked to 49 illness scripts were created, peer-reviewed, and piloted at Bushmaster. A total of 170 military members with limited medical training portrayed simulated patients utilizing the new casualty depiction system. Clinical faculty members strongly agreed that the improved casualty depiction system improved the realism of individual patient presentations (96%). Eighty-three percent of role-players strongly agreed that the casualty depiction system was easy to understand.

Conclusions: This improved casualty depiction system was a feasible approach to enhance the fidelity of a MASCAL exercise. It has since been shared with military medical units around the globe to assist with their MASCAL exercises, making future multisite evaluations of this casualty depiction system possible.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic, in addition to increased mental health difficulties for society as a whole, brought unique challenges and opportunities to mental health professionals attempting to address the issues under public health limitations. Occupationally embedded mental health professionals were uniquely challenged in quickly and creatively adjusting to physical quarantining and working from home. The purpose of this study was to inquire about and categorize the experiences of embedded mental health professionals and their clients in U.S. Air Force (USAF) operational units.

Methods: We conducted a qualitative analysis of semi-structured interviews with 26 embedded mental health professionals across 24 USAF installations and 15 Airmen clients from 5 of those installations. Their experiences within the pandemic context were systemically categorized into actionable themes through thematic content analysis.

Results: U.S. Air Force embedded mental health professionals and Airmen primarily identified the challenges of staying engaged when not face-to-face, higher incidence of mental health problems, decreased availability of clinical care and other support resources, technology as a face-to-face substitute, managing safety measures, delayed initiatives, and clinical boundary setting. Alternatively, embedded mental health professionals and Airmen identified strategies to alleviate pandemic limitations, such as using technology to interact, COVID-19 mitigating actions, developing initiatives to target their population needs, and using opportunities to help reduce stigma associated with seeking help for mental health.

Introduction: For veterans of the Persian Gulf War (1990-1991), dozens of possible causes for their illness have been proposed. We hypothesize that all may be correct. These may have weakened the immunity of the military personnel to fungal pathogens in the soil. These microbes, in turn, may have afflicted the veterans either directly by infection or indirectly by toxins.

Materials and methods: In 1990, the military (source confidential) provided the first author with soil samples from the Persian Gulf to determine if there were biothreats present. His team found that per gram of soil, there had few bacteria but many fungi. The National Centre for Human Mycotic Diseases (Edmonton) identified some of these fungi. They sent to the first author reference cultures of 12 pathogenic fungal species isolated from Canadian patients. Supernatant antigens of these fungi were used to assess if control and Gulf War Illness (GWI) patient sera had IgG antibodies against them.

Results: Human sera were tested on pathogenic fungal supernatant antigens. Controls had low IgG titers against all 12 fungal sources. Gulf War Illness (GWI) patient sera had low IgG titers against 11 of the 12 fungal antigens. However, 12 of 28 GWI patient sera (43%, P ≤ .0002 compared to controls) had high IgG titers against one fungus, Chaetomium, supernatant antigen.

Conclusions: We suggest that the military personnel in the Persian Gulf War (1990-1991) may have had their immunity weakened from a variety of causes. The role of pathogenic fungi and/or their supernatant antigens or toxins as a contributing factor to GWI should be further investigated.

Introduction: Human milk is associated with positive short- and long-term health outcomes. Women's choice to breastfeed is influenced by personal, social, health, and economic factors. The COVID-19 pandemic impacted health care delivery, non-emergent health care services, and family lifestyles, primarily in the early months of 2020. The aim of this study was to determine if breastfeeding initiation rates differed during a global pandemic among women in the military health care system.

Materials and methods: This was a cross-sectional chart review study. We compiled all birthing event health records from March to August in 2019 and 2020 from a single military medical center. Of the 2,737 maternal-infant dyads available, 1,463 met complete inclusion criteria and were analyzed to determine associations between delivery year, maternal and infant characteristics, and initial feeding methods. Institutional research approvals were obtained from the university and medical center institutional review boards.

Results: There was no significant association between breastfeeding initiation rates and delivery year (X2(1) = 2.898, P = .089). Some maternal and infant characteristics significantly associated with the feeding method in the logistic regression model and differed by delivery year. Black women were 1.9 times less likely to initiate breastfeeding compared to White women; this disparity became more pronounced in 2020. Multiparous mothers, those who gave birth via cesarean section, and those at earlier gestational ages (32-37 weeks) were less likely to initiate breastfeeding. Models differed by delivery year, with only Black race and cesarean birth significantly impacting the overall model in 2020. Maternal age, military status, military rank, marital status, birth complications, and infant gender were not associated with the feeding method.

Conclusions: Overall breastfeeding initiation rates did not differ during the COVID-19 pandemic when rates in 2020 were compared to those in the year prior. Race, birth method, parity, and gestational age were associated with breastfeeding initiation rates in women cared for at military centers.

Introduction: Although the effects of carrying loads on gait biomechanics have been well-documented, to date, little evidence has been provided whether such loads may impact spatial and temporal gait asymmetries under the different foot regions. Therefore, the main purpose of the study was to examine the effects of carrying a standardized police equipment on spatiotemporal gait parameters.

Materials and methods: In this population-based study, participants were 845 first-year police recruits (age: 21.2 ± 2.3 years; height: 178.1 ± 10.2 cm; weight: 78.4 ± 11.3 kg; body mass index: 24.7 ± 3.2 kg/m2; 609 men and 236 women; 72.1% men and 27.9% women) measured in 2 conditions: (i) "no load" and (ii) "a 3.5 kg load." Spatiotemporal gait parameters were derived from the FDM Zebris pressure platform. Asymmetry was calculated as (xright-xleft)/0.5*(xright + xleft)*100%, where "x" represented a given parameter being calculated and a value closer to 0 denoted greater symmetry.

Results: When compared to "no load" condition, a standardized 3.5 kg/7.7 lb load significantly increased asymmetries in spatial gait parameters as follows: gait phases of stance (mean diff. = 1.05), load response (mean diff. = 0.31), single limb support (mean diff. = 0.56), pre-swing (mean diff. = 0.22), and swing (mean diff. = 0.90) phase, while no significant asymmetries in foot rotation, step, and stride length were observed. For temporal gait parameters, we observed significant asymmetries in step time (mean diff. = -0.01), while no differences in cadence and gait speed were shown.

Conclusions: The findings indicate that the additional load of 3.5 kg/7.7 lb is more likely to increase asymmetries in spatial gait cycle components, opposed to temporal parameters. Thus, external police load may have hazardous effects in increasing overall body asymmetry, which may lead to a higher injury risk and a decreased performance for completing specific everyday tasks.

Introduction: Load carriage is an inherent part of tactical operations. Critical speed (CS) has been associated with technical and combat-specific performance measures (e.g., loaded running). The 3-min all-out exercise test provides estimates of CS and the maximal capacity to displace the body (D') at speeds above CS. The current study investigated the contributions of CS, D', lean body mass (LBM), thigh lean mass (TLM), and lower body isokinetic strength and endurance parameters related to load carriage time trials (LCTTs).

Methods: Twenty-two Reserve Officers' Training Corps cadets (6 = females, age = 20.82 ± 1.59 years) underwent various assessments that included a running 3-minute all-out test to determine CS and D', isokinetic knee extension (KE) muscle strength and endurance, body composition assessed by dual-energy X-ray absorption, and two 21-kg LCTTs of 400 and 3,200 m, respectively. Pearson's product-moment correlations investigated relationships between selected predictor variables. Stepwise multiple linear regression analyses were used to determine the relationship between variables that predicted LCTT performance.

Results: Significant correlations were as follows: LBM and CS (r = 0.651, P < .001), KE endurance work and CS (r = 0.645, P < .001), TLM and CS (r = 0.593, P < .05), and KE peak torque and CS (r = 0.529, P < .05). The stepwise regression analyses indicated that CS and LBM contributed significantly to predicting 3,200-m LCTT (F [2,19] = 81.85, R2 = 0.90, P < .001) with standardized β coefficients (-0.723 and -0.301, respectively). Thigh lean mass contributed significantly to predicting the 400-m LCTT (F [1,20] = 46.586, R2 = 0.70, P < .001) with a standardized β coefficient (-0.836).

Conclusion: The results of this study highlight that CS and LBM were the best predictors of the 3,200-m LCTT, and TLM was the best predictor of the 400-m LCTT. The findings of this study support that CS and LBM, including TLM, are important in predicting load carriage task completion in the time trial tasks.

Introduction: As illustrated by the "Walker Dip," there is growing concern regarding the lack of combat casualty care during peacetime. Surgical volume and case complexity are paramount for training and skill sustainment. We sought to quantify the recent orthopedic trauma surgical case load of all military orthopedic surgeons across the Military Health System (MHS).

Materials and methods: We queried the United States MHS Data Repository for orthopedic trauma-related Current Procedural Terminology codes for which the Accreditation Council for Graduate Medical Education (ACGME) requires graduating residents to perform a minimum case volume: hip fracture, femur/tibia shaft fracture, pilon fracture, and ankle fracture. The search yielded all corresponding procedures performed between January 2017 and December 2023 within the MHS.

Results: There were 15,873 total ACGME-minimum orthopedic trauma procedures performed across the MHS during the study period (2,268 cases per year) for the fixation of 3,283 hip fractures, 805 femoral shaft fractures, 1,455 tibial shaft fractures, and 10,330 ankle or pilon fractures. The sole level I trauma center in the MHS, which accepts civilian trauma, performed 21% of all cases. Civilian trauma made up 70% of this military treatment facility's volume. For another military treatment facility that began accepting civilian trauma in the middle of the study period, the volume increased from 49 to 123 cases per year.

Conclusion: Across the MHS, there was a low volume of ACGME-minimum orthopedic trauma procedures performed. These data help to frame the current orthopedic trauma surgical volume in the United States MHS in support of efforts to maximize military surgeon training and readiness, ultimately in preparation for future conflicts.